Even as the Republican health care overhaul remains a work in progress, states are planning for big changes that could swell the ranks of the uninsured and hit them with higher costs.
A key tenet underlying the GOP plan is to give states more authority over how to structure their health care markets. That approach is welcome in states that want fewer mandates from the federal government but is causing alarm in states that embraced former President Barack Obama’s Affordable Care Act.
This is especially true for states that, like Ohio, expanded their Medicaid programs and could now see a huge pool of federal health care money evaporate. They will face tough decisions about balancing costs and care.
States’ preparations come even as Republican members of the U.S. Senate promise significant revisions to the health care bill that narrowly passed last week in the House. Some governors already have begun pressing their senators to soften the bill in ways that would lessen the financial blow to the states.
"Ohio is one of 31 states (and Washington D.C.) to expand Medicaid eligibility as part of the Affordable Care Act. The move, which came in January 2014, made eligible those adults with incomes below 138 percent of the federal poverty level." -- OSU.edu
Ohio Gov. John Kasich, a former Republican candidate for president, has been consistently critical of his own party’s attempts to make deep cuts in the Medicaid program. He supported Medicaid expansion in his state and called the House bill “woefully short on the necessary resources to maintain health care for our nation’s most vulnerable citizens.”
Underscoring those concerns, Ohio Sen. Rob Portman, a Republican, said he does not support the House bill in its current form, in part because it does not protect Ohioans who benefited from the Medicaid expansion.
No viable option
A recent Ohio State University study found that almost everyone covered through Ohio’s Medicaid expansion would have no other viable insurance option if the Affordable Care Act is repealed. That’s roughly 712,000 people.
“Many of these people have nothing else to turn to,” said Eric Seiber, lead author and associate professor of health services management and policy in Ohio State’s College of Public Health. “Their choice is Medicaid or medical bankruptcy.”
MORE: Medicaid Expansion and ACA Repeal: Evidence From Ohio
State Medicaid data also show that Ohio schools would lose about $8 million a year in Medicaid funding for special education services under the House bill.
Who wins? Who loses?
Katherine Hempstead, who analyzes health policy at the Robert Wood Johnson Foundation, said she does not expect any states to be able to afford keeping the Medicaid expansion in place. But she said some could choose to use federal money for subsidies, in addition to what would be offered anyway, for people who buy insurance on the individual market. In many states, premiums have been rising and insurance choices dwindling.
“States might face a choice of what population they want to reinforce,” she said.
Under the House bill, states would be allowed to reduce coverage requirements for people who buy individual insurance plans while allowing insurers to charge higher premiums to older people and those with pre-existing conditions if they had a lapse in coverage. States taking that step would have to establish government-operated insurance programs for expensive patients called high-risk pools.
